Skip to main content
Top
Published in: Current Rheumatology Reports 12/2017

01-12-2017 | Systemic Lupus Erythematosus (G Tsokos, Section Editor)

B Cell-Based Treatments in SLE: Past Experience and Current Directions

Authors: Stamatis-Nick C. Liossis, Chrysanthi Staveri

Published in: Current Rheumatology Reports | Issue 12/2017

Login to get access

Abstract

Purpose of Review

B cells have been targeted recently by novel therapeutic approaches in patients with SLE. In this review, we discuss recent data that have emerged on this issue placing special emphasis in studies published during the last 5 years.

Recent Findings

Despite the negative results stemming from double-blind placebo-controlled studies, B cell depletion with rituximab is indeed employed worldwide, particularly in standard treatment refractory lupus, with promising results. In addition, positive experience with the approved agent belimumab is steadily increasing. Both regimens have an acceptable safety profile.

Summary

Identification of B cells as a therapeutic target in SLE has been so far rewarding, since one such treatment, belimumab, has been the only regulatory authority-approved medication in SLE for over half a century. Focusing specifically on autoreactive instead of non-specifically altering/depleting lupus, B cells may lead to more rational treatment modes.
Literature
1.
go back to reference Liossis SN, Kovacs B, Dennis G, Kammer GM, Tsokos GC. B cells from patients with systemic lupus erythematosus display abnormal antigen receptor-mediated early signal transduction events. J Clin Invest. 1996;98(11):2549–57.CrossRefPubMedPubMedCentral Liossis SN, Kovacs B, Dennis G, Kammer GM, Tsokos GC. B cells from patients with systemic lupus erythematosus display abnormal antigen receptor-mediated early signal transduction events. J Clin Invest. 1996;98(11):2549–57.CrossRefPubMedPubMedCentral
4.
go back to reference Iaccarino L, Bartoloni E, Carli L, et al. Efficacy and safety of off-label use of rituximab in refractory lupus: data from the Italian Multicentre Registry. Clin Exp Rheumatol. 2015;33(4):449–56.PubMed Iaccarino L, Bartoloni E, Carli L, et al. Efficacy and safety of off-label use of rituximab in refractory lupus: data from the Italian Multicentre Registry. Clin Exp Rheumatol. 2015;33(4):449–56.PubMed
9.
go back to reference Tsanian MÉ, Solov'ev SK, Torgashina AV, Aleksandrova EN, Radenska-Lopovok SG, Nikolaeva EV, et al. Long-term follow-up of patients with refractory systemic lupus erythematosus during rituximab treatment. Ter Arkh. 2014;86(5):40–9.PubMed Tsanian MÉ, Solov'ev SK, Torgashina AV, Aleksandrova EN, Radenska-Lopovok SG, Nikolaeva EV, et al. Long-term follow-up of patients with refractory systemic lupus erythematosus during rituximab treatment. Ter Arkh. 2014;86(5):40–9.PubMed
10.
go back to reference • Aguiar R, Araújo C, Martins-Coelho G, Isenberg D. Use of rituximab in systemic lupus erythematosus: a single center experience over 14 years. Arthritis Care Res (Hoboken). 2017;69(2):257–62. https://doi.org/10.1002/acr.22921. Although retrospective, this study analyzes results from a large number of patients with SLE for a period over a decade.CrossRef • Aguiar R, Araújo C, Martins-Coelho G, Isenberg D. Use of rituximab in systemic lupus erythematosus: a single center experience over 14 years. Arthritis Care Res (Hoboken). 2017;69(2):257–62. https://​doi.​org/​10.​1002/​acr.​22921. Although retrospective, this study analyzes results from a large number of patients with SLE for a period over a decade.CrossRef
11.
go back to reference Staveri, Liossis SN. Rituximab for SLE refractory to conventional treatment: results of a cohort evaluating efficacy and long-term outcome. Clin Exp Rheumatol. 2016;34(4):S5. Staveri, Liossis SN. Rituximab for SLE refractory to conventional treatment: results of a cohort evaluating efficacy and long-term outcome. Clin Exp Rheumatol. 2016;34(4):S5.
13.
go back to reference Hahn BH, McMahon M, Wilkinson A, Wallace WD, Daikh DI, FitzGerald J, et al. American College of Rheumatology guidelines for screening, case definition, treatment and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797–808.CrossRef Hahn BH, McMahon M, Wilkinson A, Wallace WD, Daikh DI, FitzGerald J, et al. American College of Rheumatology guidelines for screening, case definition, treatment and management of lupus nephritis. Arthritis Care Res (Hoboken). 2012;64(6):797–808.CrossRef
16.
go back to reference • Condon MB, Ashby D, Pepper RJ, Cook HT, Levy JB, Griffith M, et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis. 2013;72(8):1280–6. https://doi.org/10.1136/annrheumdis-2012-202844. A highly interesting study addressing the efficacy of RTX + MMF combination in patients with lupus nephritis, without the addition of oral corticosteroids. Despite the lack of a control group and the exclusion of patients with rapidly progressive nephritis, results are promising compared to those reported from other, placebo-controlled randomized trials in patients with LN.CrossRefPubMed • Condon MB, Ashby D, Pepper RJ, Cook HT, Levy JB, Griffith M, et al. Prospective observational single-centre cohort study to evaluate the effectiveness of treating lupus nephritis with rituximab and mycophenolate mofetil but no oral steroids. Ann Rheum Dis. 2013;72(8):1280–6. https://​doi.​org/​10.​1136/​annrheumdis-2012-202844. A highly interesting study addressing the efficacy of RTX + MMF combination in patients with lupus nephritis, without the addition of oral corticosteroids. Despite the lack of a control group and the exclusion of patients with rapidly progressive nephritis, results are promising compared to those reported from other, placebo-controlled randomized trials in patients with LN.CrossRefPubMed
21.
32.
33.
go back to reference Wallace DJ, Gordon C, Strand V, Hobbs K, Petri M, Kalunian K, et al. Efficacy and safety of epratuzumab in patients with moderate/severe flaring systemic lupus erythematosus: results from two randomized, double-blind, placebo-controlled, multicentre studies (ALLEVIATE) and follow-up. Rheumatology (Oxford). 2013;52(7):1313–22. https://doi.org/10.1093/rheumatology/ket129.CrossRef Wallace DJ, Gordon C, Strand V, Hobbs K, Petri M, Kalunian K, et al. Efficacy and safety of epratuzumab in patients with moderate/severe flaring systemic lupus erythematosus: results from two randomized, double-blind, placebo-controlled, multicentre studies (ALLEVIATE) and follow-up. Rheumatology (Oxford). 2013;52(7):1313–22. https://​doi.​org/​10.​1093/​rheumatology/​ket129.CrossRef
34.
go back to reference Wallace DJ, Hobbs K, Clowse ME, Petri M, Strand V, Pike M, et al. Long-term safety and efficacy of epratuzumab in the treatment of moderate-to- severe systemic lupus erythematosus: results from an open-label extension study. Arthritis Care Res (Hoboken). 2016;68(4):534–43. https://doi.org/10.1002/acr.22694.CrossRef Wallace DJ, Hobbs K, Clowse ME, Petri M, Strand V, Pike M, et al. Long-term safety and efficacy of epratuzumab in the treatment of moderate-to- severe systemic lupus erythematosus: results from an open-label extension study. Arthritis Care Res (Hoboken). 2016;68(4):534–43. https://​doi.​org/​10.​1002/​acr.​22694.CrossRef
35.
go back to reference Strand V, Petri M, Kalunian K, Gordon C, Wallace DJ, Hobbs K, et al. Epratuzumab for patients with moderate to severe flaring SLE: health-related quality of life outcomes and corticosteroid use in the randomized controlled ALLEVIATE trials and extension study SL0006. Rheumatology (Oxford). 2014;53(3):502–11. https://doi.org/10.1093/rheumatology/ket378.CrossRef Strand V, Petri M, Kalunian K, Gordon C, Wallace DJ, Hobbs K, et al. Epratuzumab for patients with moderate to severe flaring SLE: health-related quality of life outcomes and corticosteroid use in the randomized controlled ALLEVIATE trials and extension study SL0006. Rheumatology (Oxford). 2014;53(3):502–11. https://​doi.​org/​10.​1093/​rheumatology/​ket378.CrossRef
38.
39.
go back to reference Strand V, Levy RA, Cervera R, Petri MA, Birch H, Freimuth WW, et al. Improvements in health-related quality of life with belimumab, a B-lymphocyte stimulator-specific inhibitor, in patients with autoantibody-positive systemic lupus erythematosus from the randomised controlled BLISS trials. Ann Rheum Dis. 2014;73(5):838–44. https://doi.org/10.1136/annrheumdis-2012-202865.CrossRefPubMed Strand V, Levy RA, Cervera R, Petri MA, Birch H, Freimuth WW, et al. Improvements in health-related quality of life with belimumab, a B-lymphocyte stimulator-specific inhibitor, in patients with autoantibody-positive systemic lupus erythematosus from the randomised controlled BLISS trials. Ann Rheum Dis. 2014;73(5):838–44. https://​doi.​org/​10.​1136/​annrheumdis-2012-202865.CrossRefPubMed
45.
go back to reference Schwarting A, Dooley MA, Roth DA, Edwards L, Thompson A, Wilson B. Impact of concomitant medication use on belimumab efficacy and safety in patients with systemic lupus erythematosus. Lupus. 2016;25(14):1587–96.CrossRefPubMedPubMedCentral Schwarting A, Dooley MA, Roth DA, Edwards L, Thompson A, Wilson B. Impact of concomitant medication use on belimumab efficacy and safety in patients with systemic lupus erythematosus. Lupus. 2016;25(14):1587–96.CrossRefPubMedPubMedCentral
46.
go back to reference Collins CE, Dall’Era M, Kan H, et al. Response to belimumab among patients with systemic lupus erythematosus in clinical practice settings: 24-month results from the OBSErve study in the USA. Lupus Sci Med. 2016;3:e000118.CrossRefPubMedPubMedCentral Collins CE, Dall’Era M, Kan H, et al. Response to belimumab among patients with systemic lupus erythematosus in clinical practice settings: 24-month results from the OBSErve study in the USA. Lupus Sci Med. 2016;3:e000118.CrossRefPubMedPubMedCentral
49.
go back to reference Andreoli L, Reggia R, Pea L, Frassi M, Zanola A, Cartella S, et al. Belimumab for the treatment of refractory systemic lupus erythematosus: real-life experience in the first year of use in 18 Italian patients. Isr Med Assoc J. 2014;16(10):651–3.PubMed Andreoli L, Reggia R, Pea L, Frassi M, Zanola A, Cartella S, et al. Belimumab for the treatment of refractory systemic lupus erythematosus: real-life experience in the first year of use in 18 Italian patients. Isr Med Assoc J. 2014;16(10):651–3.PubMed
51.
go back to reference Schwarting A, Schroeder JO, Alexander T, Schmalzing M, Fiehn C, Specker C, et al. First real-world insights into belimumab use and outcomes in routine clinical care of systemic lupus erythematosus in Germany: results from the OBSErve Germany Study. Rheumatol Ther. 2016;3(2):271–90.CrossRefPubMedPubMedCentral Schwarting A, Schroeder JO, Alexander T, Schmalzing M, Fiehn C, Specker C, et al. First real-world insights into belimumab use and outcomes in routine clinical care of systemic lupus erythematosus in Germany: results from the OBSErve Germany Study. Rheumatol Ther. 2016;3(2):271–90.CrossRefPubMedPubMedCentral
52.
go back to reference Scheinberg M, de Melo FF, Bueno AN, Costa CM, de Azevedo Bahr ML, Reis ER. Belimumab for the treatment of corticosteroid-dependent systemic lupus erythematosus: from clinical trials to real-life experience after 1 year of use in 48 Brazilian patients. Clin Rheumatol. 2016;35(7):1719–23. https://doi.org/10.1007/s10067-016-3268-z.CrossRefPubMed Scheinberg M, de Melo FF, Bueno AN, Costa CM, de Azevedo Bahr ML, Reis ER. Belimumab for the treatment of corticosteroid-dependent systemic lupus erythematosus: from clinical trials to real-life experience after 1 year of use in 48 Brazilian patients. Clin Rheumatol. 2016;35(7):1719–23. https://​doi.​org/​10.​1007/​s10067-016-3268-z.CrossRefPubMed
53.
go back to reference Sthoeger Z, Lorber M, Tal Y, Toubi E, Amital H, Kivity S, et al. Anti-BLyS treatment of 36 Israeli systemic lupus erythematosus patients. Isr Med Assoc J. 2017;19(1):44–8.PubMed Sthoeger Z, Lorber M, Tal Y, Toubi E, Amital H, Kivity S, et al. Anti-BLyS treatment of 36 Israeli systemic lupus erythematosus patients. Isr Med Assoc J. 2017;19(1):44–8.PubMed
56.
go back to reference Lee YH, Song GG. Comparative efficacy and safety of intravenous or subcutaneous belimumab in combination with standard therapy in patients with active systemic lupus erythematosus: a Bayesian network meta-analysis of randomized controlled trials. Lupus. 2017;1:961203317713143. https://doi.org/10.1177/0961203317713143. Lee YH, Song GG. Comparative efficacy and safety of intravenous or subcutaneous belimumab in combination with standard therapy in patients with active systemic lupus erythematosus: a Bayesian network meta-analysis of randomized controlled trials. Lupus. 2017;1:961203317713143. https://​doi.​org/​10.​1177/​0961203317713143​.
59.
go back to reference Flieber EE, Korsten P, Koziolek MJ, Niewold TB, Patchan D, Muller GA, et al. Successful treatment of a mycophenolate mofetil-refractory proliferative lupus nephritis with Belimumab in a 19-year-old woman. Lupus. 2013;22:1523–5.CrossRef Flieber EE, Korsten P, Koziolek MJ, Niewold TB, Patchan D, Muller GA, et al. Successful treatment of a mycophenolate mofetil-refractory proliferative lupus nephritis with Belimumab in a 19-year-old woman. Lupus. 2013;22:1523–5.CrossRef
60.
go back to reference De Sceerder M-A, Boey O, Mahieu E, Vanuytsel J, Bogaert A-M. Case report: successful treatment of membranous lupus nephritis with belimumab in an African female immigrant. Clin Rheumatol. 2016;35:1649–53.CrossRef De Sceerder M-A, Boey O, Mahieu E, Vanuytsel J, Bogaert A-M. Case report: successful treatment of membranous lupus nephritis with belimumab in an African female immigrant. Clin Rheumatol. 2016;35:1649–53.CrossRef
61.
go back to reference Sjӧwall C, Cӧster L. Belimumab may not prevent lupus nephritis in serologically active patients with ongoing non-renal disease activity. Scand J Rheumatol. 2014;43(5):428–30.CrossRef Sjӧwall C, Cӧster L. Belimumab may not prevent lupus nephritis in serologically active patients with ongoing non-renal disease activity. Scand J Rheumatol. 2014;43(5):428–30.CrossRef
62.
go back to reference • Staveri C, Karokis D, Liossis SNC. New onset of lupus nephritis in two patients with SLE shortly after initiation of treatment with belimumab. Semin Arthritis Rheum. 2017;46(6):788–90. https://doi.org/10.1016/j.semarthrit.2016.09.006. Although limited to 2 patients, this report identifies 2 patients developing LN shortly after belimumab initiation. Nephritis underwent a complete response following belimumab withdrawal.CrossRefPubMed • Staveri C, Karokis D, Liossis SNC. New onset of lupus nephritis in two patients with SLE shortly after initiation of treatment with belimumab. Semin Arthritis Rheum. 2017;46(6):788–90. https://​doi.​org/​10.​1016/​j.​semarthrit.​2016.​09.​006. Although limited to 2 patients, this report identifies 2 patients developing LN shortly after belimumab initiation. Nephritis underwent a complete response following belimumab withdrawal.CrossRefPubMed
63.
go back to reference Gonzalez-Echavarri C, Uqarte A, Ruiz-Irastorza G. Rituximab-refractory lupus nephritis successfully treated with belimumab. Clin Exp Rheumatol. 2016;34(2):355–6.PubMed Gonzalez-Echavarri C, Uqarte A, Ruiz-Irastorza G. Rituximab-refractory lupus nephritis successfully treated with belimumab. Clin Exp Rheumatol. 2016;34(2):355–6.PubMed
65.
go back to reference Kraaij T, Huizinga TW, Rabelink TJ, Teng YK. Belimumab after rituximab as maintenance therapy in lupus nephritis. Rheumatology (Oxford). 2014;53(11):2122–4.CrossRef Kraaij T, Huizinga TW, Rabelink TJ, Teng YK. Belimumab after rituximab as maintenance therapy in lupus nephritis. Rheumatology (Oxford). 2014;53(11):2122–4.CrossRef
68.
go back to reference Petri MA, Martin RS, Scheinberg MA, Furie RA. Assessments of fatigue and disease activity in patients with systemic lupus erythematosus enrolled in the phase 2 clinical trial with blisibimod. Lupus. 2017;26(1):27–37.CrossRefPubMed Petri MA, Martin RS, Scheinberg MA, Furie RA. Assessments of fatigue and disease activity in patients with systemic lupus erythematosus enrolled in the phase 2 clinical trial with blisibimod. Lupus. 2017;26(1):27–37.CrossRefPubMed
69.
go back to reference Isenberg DA, Petri M, Kalunian K, Tanaka Y, Urowitz MB, Hoffman RW, et al. Efficacy and safety of subcutaneous tabalumab in patients with systemic lupus erythematosus: results from ILLUMINATE-1, a 52-week, phase III, multicentre, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2016;75(2):323–31. https://doi.org/10.1136/annrheumdis-2015-207653.CrossRefPubMed Isenberg DA, Petri M, Kalunian K, Tanaka Y, Urowitz MB, Hoffman RW, et al. Efficacy and safety of subcutaneous tabalumab in patients with systemic lupus erythematosus: results from ILLUMINATE-1, a 52-week, phase III, multicentre, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2016;75(2):323–31. https://​doi.​org/​10.​1136/​annrheumdis-2015-207653.CrossRefPubMed
70.
go back to reference Merrill JT, van Vollenhoven RF, Buyon JP, Furie RA, Stohl W, Morgan-Cox M, et al. Efficacy and safety of subcutaneous tabalumab, a monoclonal antibody to B-cell activating factor, in patients with systemic lupus erythematosus: results from ILLUMINATE-2, a 52-week, phase III, multicentre, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2016;75(2):332–40. https://doi.org/10.1136/annrheumdis-2015-207654.CrossRefPubMed Merrill JT, van Vollenhoven RF, Buyon JP, Furie RA, Stohl W, Morgan-Cox M, et al. Efficacy and safety of subcutaneous tabalumab, a monoclonal antibody to B-cell activating factor, in patients with systemic lupus erythematosus: results from ILLUMINATE-2, a 52-week, phase III, multicentre, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2016;75(2):332–40. https://​doi.​org/​10.​1136/​annrheumdis-2015-207654.CrossRefPubMed
72.
go back to reference Rovin BH, Dooley MA, Radhakrishnan J, Ginzler EM, Forrester TD, Anderson PW. The impact of tabalumab on the kidney in systemic lupus erythematosus: results from two phase 3 randomized, clinical trials. Lupus. 2016;25(14):1597–601.CrossRefPubMed Rovin BH, Dooley MA, Radhakrishnan J, Ginzler EM, Forrester TD, Anderson PW. The impact of tabalumab on the kidney in systemic lupus erythematosus: results from two phase 3 randomized, clinical trials. Lupus. 2016;25(14):1597–601.CrossRefPubMed
73.
go back to reference Isenberg D, Gordon C, Licu D, Copt S, Rossi CP, Wofsy D. Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial). Ann Rheum Dis. 2015;74(11):2006–15. https://doi.org/10.1136/annrheumdis-2013-205067. Erratum in: Ann Rheum Dis. 2016; 75(5):946 Isenberg D, Gordon C, Licu D, Copt S, Rossi CP, Wofsy D. Efficacy and safety of atacicept for prevention of flares in patients with moderate-to-severe systemic lupus erythematosus (SLE): 52-week data (APRIL-SLE randomised trial). Ann Rheum Dis. 2015;74(11):2006–15. https://​doi.​org/​10.​1136/​annrheumdis-2013-205067. Erratum in: Ann Rheum Dis. 2016; 75(5):946
Metadata
Title
B Cell-Based Treatments in SLE: Past Experience and Current Directions
Authors
Stamatis-Nick C. Liossis
Chrysanthi Staveri
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Rheumatology Reports / Issue 12/2017
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-017-0707-z

Other articles of this Issue 12/2017

Current Rheumatology Reports 12/2017 Go to the issue

Systemic Lupus Erythematosus (G Tsokos, Section Editor)

Renal Macrophages and Dendritic Cells in SLE Nephritis

Pediatric Rheumatology (S Ozen, Section Editor)

Clinical Outcome and Long-term Remission in JIA

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine